Abstract

Background The safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.

Methods A EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.

Interpretation Overall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.

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Footnotes

Contributors KKK, GA, SCS and CHH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. KKK, GA, MTB, NRW, SCS and CHH were responsible for study concept and design. KKK, GA, LLBS, MTB, NRW, SCS and CHH were responsible for the acquisition, analysis and interpretation of data. KKK, GA, MTB, NRW, SCS and CH drafted the manuscript. KKK, GA, ALC, MTB, NRW, SCS and CHH critically revised the manuscript for important intellectual content. KKK, GA, SCS and CHH were responsible for the statistical analysis. CHH obtained the funding and was responsible for study supervision. CHH, SCS and KKK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding This study was supported by funds from the John A. Blume Foundation, the William Randolph Hearst Foundation and start-up funds from Stanford University’s Department of Neurosurgery.

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